A case of metastatic adrenal cortical carcinoma diagnosed by needle aspiration cytology of the liver

A case of adrenal cortical carcinoma is reported. A 60-year-old woman with liver dysfunction, hypokalemia, hypertension and edema was admitted to our hospital for treatment. A CT scan revealde multiple nodular lesions of the liver and a mass lesion in the suprarenal region. Needle aspiration cytology of the liver yielded the following: 1) Numerous malignant cells were found in clusters or as scattered isolated cells with a necrotic background. 2) Multi-nucleated large cells with marked atypia, and small cells with round nuclei were present together. 3) The tumor cells had a high nucleus to cytoplasm ratio. The cytoplasm stained light green and had an indistinguishable margin. Bare nucleated cells were also seen. 4) The nuclear chromatin in small tumor cells was fine, and rough and unevenly distributed was observed in large cells. There were prominent single or multiplenucleoli. Based on the cytological and clinical findings, we made a diagnosis of cortical carcinoma with liver metastasis. This case showed evidence of Cushing's syndrome in the form of excess adrenocortical hormones on laboratory examination. Immunohistochemical studies of imprint smears from autopsy material showed that most tumor cells stained positive for cortisol and vimentin, but negative for cytokeratin. Histologically, tumor cells with eosinophilic cytoplasm proliferated solidly and displayed a trabecular or alveolar arrangement. The tumor was diagnosed as adrenal coltical carcinoma.